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Open AccessArticle

Heterogeneity in the Relationship between Disinfection By-Products in Drinking Water and Cancer: A Systematic Review

Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California, San Diego, CA 92093, USA
École Supérieure D’aménagement du Territoire et de Développement Régional (ESAD), Université Laval, 1624 Pavillon Savard, Québec, QC G1K-7P4, Canada
Direction de la Santé Environnementale et de la Toxicologie, Institut National de Santé Publique du Québec, Québec, QC G1V 5B3, Canada
Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, QC G1V 2M2, Canada
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Environ. Res. Public Health 2018, 15(5), 979;
Received: 28 February 2018 / Revised: 7 May 2018 / Accepted: 9 May 2018 / Published: 14 May 2018
(This article belongs to the Special Issue Drinking Water Quality and Human Health)
The epidemiological evidence demonstrating the effect of disinfection by-products (DBPs) from drinking water on colon and rectal cancers is well documented. However, no systematic assessment has been conducted to assess the potential effect measure modification (EMM) in the relationship between DBPs and cancer. The objective of this paper is to conduct a systematic literature review to determine the extent to which EMM has been assessed in the relationship between DBPs in drinking water in past epidemiological studies. Selected articles (n = 19) were reviewed, and effect estimates and covariates that could have been used in an EMM assessment were gathered. Approximately half of the studies assess EMM (n = 10), but the majority of studies only estimate it relative to sex subgroups (n = 6 for bladder cancer and n = 2 both for rectal and colon cancers). Although EMM is rarely assessed, several variables that could have a potential modification effect are routinely collected in these studies, such as socioeconomic status or age. The role of environmental exposures through drinking water can play an important role and contribute to cancer disparities. We encourage a systematic use of subgroup analysis to understand which populations or territories are more vulnerable to the health impacts of DBPs. View Full-Text
Keywords: THMs; cancer; effect measure modification; drinking water THMs; cancer; effect measure modification; drinking water
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Benmarhnia, T.; Delpla, I.; Schwarz, L.; Rodriguez, M.J.; Levallois, P. Heterogeneity in the Relationship between Disinfection By-Products in Drinking Water and Cancer: A Systematic Review. Int. J. Environ. Res. Public Health 2018, 15, 979.

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